Topic Contents

Nausea and Vomiting, Age 11 and Younger

Topic Overview

Vomiting occurs when a child's stomach contents are forced up the esophagus and out of the mouth. Although nausea may accompany vomiting in adults and older children, children younger than age 3 are usually not able to tell you if they are having nausea. Most of the time vomiting is not serious. Home treatment will often ease your child's discomfort.

Vomiting in a baby should not be confused with spitting up. Vomiting is forceful and repeated. Spitting up may seem forceful but it usually occurs shortly after feeding, is effortless, and causes no discomfort.

Causes of vomiting

A baby may spit up for no reason at all. Overfeeding, not burping your baby after feeding, intolerance to milk or formula, and exposure to tobacco smoke are other reasons why your baby may spit up.

Most vomiting in children is caused by a viral stomach illness (gastroenteritis). A child with a stomach illness also may have other symptoms, such as diarrhea, fever, and stomach cramps. With home treatment, the vomiting usually will stop within 12 hours. Diarrhea may last for a few days or more.

When a toddler vomits, it is important to make sure he or she has not swallowed medicines, household liquids, or other poisons. Look around the house for empty containers and spills. There may be pills in your child's vomit, or the vomit may have an unusual appearance, color, or odor. For more information, see the topic Poisoning.

A child who falls down and forcefully hits his or her head or belly may vomit because of an injury to those areas. Check your child's body for bruises and other injuries.

Treatment

Babies and children younger than 1 year old need special attention if they continue to vomit. They can quickly become dehydrated. It is important to replace lost fluids when your child is vomiting. Watch your child carefully, and pay close attention to the amount of fluid he or she is able to drink. Look for early symptoms of dehydration:

The mouth and eyes may be drier than usual.

The urine may be less than usual.

He or she may feel cranky, tired, or dizzy.

Also, be sure to notice the color of the vomit, and count the number of times your child vomits. If your child vomits so frequently that you can't get him or her to drink or vomits every time he or she takes a drink, the risk of dehydration is greater.

Taking a rectal temperature is the only way to be sure that a baby this age does not have a fever. If you don't know the rectal temperature, it's safest to assume the baby has a fever and needs to be seen by a doctor. Any problem that causes a fever at this age could be serious.

Yes

Rectal temperature taken

No

Rectal temperature taken

Is it 100.4°F (38°C) or higher?

Yes

Temperature at least 100.4°F (38°C)

No

Temperature at least 100.4°F (38°C)

Within the past week, has your child had an injury to the abdomen, like a blow to the belly or a hard fall?

Yes

Abdominal injury within past week

No

Abdominal injury within past week

Do you think the nausea or vomiting may be caused by an injury or by abuse?

Shaking chills are a severe, intense form of shivering. Heavy sweating means that sweat is pouring off the child or soaking through his or her clothes.

Yes

Shaking chills or heavy sweating

No

Shaking chills or heavy sweating

Has there been any blood, yellow or green liquid (bile), or what looks like coffee grounds in the vomit?

Sometimes a food (like yellow squash or green peas) can be the reason for the vomit's color. But unless food is the obvious cause, vomit that is yellow, green, or bloody may be a sign of a serious medical problem.

Yes

Blood or yellow or green liquid (bile) in vomit

No

Blood or yellow or green liquid (bile) in vomit

Has your baby vomited after 2 feedings in a row?

Vomiting is not the same as spitting up. Spitting up usually occurs right after eating, happens easily without any effort by the child, and is not forceful or painful like vomiting can be.

Yes

Vomited after 2 feedings in a row

No

Vomited after 2 feedings in a row

Has your child vomited?

Yes

Vomiting

No

Vomiting

Has there been any blood, yellow or green liquid (bile), or what looks like coffee grounds in the vomit?

Sometimes a food (like yellow squash or green peas) can be the reason for the vomit's color. But unless food is the obvious cause, vomit that is yellow, green, or bloody may be a sign of a serious medical problem.

Yes

Blood or yellow or green liquid (bile) in vomit

No

Blood or yellow or green liquid (bile) in vomit

How much blood or bile has your child vomited?

Vomit is mostly blood or bile, or contains what looks like coffee grounds

Vomit is mostly blood or bile, or contains material that looks like coffee grounds

Streaks of blood or a small amount of bile

Streaks of blood or small amount of bile in vomit

Is your child vomiting all the time, again and again, or is your child vomiting just now and then?

Temperature varies a little depending on how you measure it.
For children up to 11 years old, here are the ranges for high, moderate, and
mild according to how you took the temperature.

Oral (by mouth), ear, or rectal temperature

High:
104°F (40°C) and
higher

Moderate:
100.4°F (38°C) to
103.9°F (39.9°C)

Mild:
100.3°F (37.9°C) and
lower

A forehead (temporal) scanner is usually 0.5°F (0.3°C) to 1°F (0.6°C) lower than an oral temperature.

Armpit (axillary) temperature

High: 103°F (39.5°C) and higher

Moderate:
99.4°F (37.4°C) to
102.9°F (39.4°C)

Mild: 99.3°F (37.3°C) and lower

Note: For children under 5 years old, rectal temperatures are
the most accurate.

Babies can quickly get dehydrated when they lose fluids because of problems like
vomiting or fever.

Symptoms of dehydration can range from mild to
severe. For example:

The baby may be fussy or cranky (mild dehydration),
or the baby may be very sleepy and hard to wake up (severe
dehydration).

The baby may have a little less urine than usual
(mild dehydration), or the baby may not be urinating at all (severe
dehydration).

You can get dehydrated when
you lose a lot of fluids because of problems like vomiting or fever.

Symptoms of dehydration can range from mild to severe. For
example:

You may feel tired and edgy (mild dehydration), or
you may feel weak, not alert, and not able to think clearly (severe
dehydration).

You may pass less urine than usual (mild
dehydration), or you may not be passing urine at all (severe
dehydration).

Severe dehydration means:

The baby may be very sleepy and hard to wake
up.

The baby may have a very dry mouth and very dry eyes (no
tears).

The baby may have no wet diapers in 12 or more hours.

Moderate dehydration means:

The baby may have no wet diapers in 6 hours.

The
baby may have a dry mouth and dry eyes (fewer tears than usual).

Mild dehydration means:

The baby may pass a little less urine than usual.

Severe dehydration means:

The child's mouth and eyes may be extremely dry.

The child may pass little or no urine for 12 or more
hours.

The child may not seem alert or able to think clearly.

The child may be too weak or dizzy to stand.

The
child may pass out.

Moderate dehydration means:

The child may be a lot more thirsty than
usual.

The child's mouth and eyes may be drier than
usual.

The child may pass little or no urine for 8 or more hours.

The child may feel dizzy when he or she stands or sits up.

Mild dehydration means:

The child may be more thirsty than
usual.

The child may pass less urine than usual.

Many nonprescription and prescription medicines can cause
nausea or vomiting. A few examples are:

Antibiotics.

Antidepressants.

Aspirin, ibuprofen (such as Advil or
Motrin), and naproxen (such as Aleve).

Medicines used to treat
cancer (chemotherapy).

Opioid pain
medicines.

Vitamins and mineral supplements, such as iron.

Starting a new medicine or increasing the dose can cause nausea
and vomiting. Nausea and vomiting also may mean that there is too much medicine
in your body, even if you took it properly.

Repeated vomiting: The child vomits
nearly every time he or she tries to drink something. This type of vomiting
makes it impossible to keep down any fluids or solid food, which greatly
increases the chance of becoming dehydrated. The child has an even greater
chance of dehydration if he or she also has diarrhea.

Occasional vomiting: Some young children vomit every once in a
while for no clear reason. This usually does not increase the risk of
dehydration or other problems as long as the child can keep down fluids between
vomiting. The more time that passes between episodes of vomiting, the less
serious it probably is. But if the vomiting continues, it may be important to
find the cause.

Symptoms of serious illness in a baby
may include the following:

The baby is limp and floppy like a rag doll.

The baby doesn't respond at all to being held, touched, or talked
to.

The baby is hard to wake up.

Symptoms of serious illness may
include:

A severe headache.

A stiff
neck.

Mental changes, such as feeling confused or much less
alert.

Extreme fatigue (to the point where it's hard for you to
function).

Shaking chills.

An illness plan for people with diabetes usually covers things like:

How often to test blood sugar and what the target
range is.

Whether and how to adjust the dose and timing of insulin
or other diabetes medicines.

What to do if you have trouble keeping
food or fluids down.

When to call your doctor.

The plan is designed to help keep your diabetes in control even
though you are sick. When you have diabetes, even a minor illness can cause
problems.

It is easy for your diabetes to become out of control when
you are sick. Because of an illness:

Your blood sugar may be too high or too
low.

You may not be able take your diabetes medicine (if you are
vomiting or having trouble keeping food or fluids down).

You may
not know how to adjust the timing or dose of your diabetes
medicine.

You may not be eating enough or drinking enough
fluids.

Colic is an extreme type of crying in
a baby between 3 weeks and 3 months of age. All babies cry, but a colicky baby
will cry for hours at a time, no matter what you do.

During a
crying episode, a colicky baby may cry loudly and continuously and be hard to
comfort. The baby may get red in the face, clench the fists, and arch his or
her back or pull the legs up to the belly.

A baby that is extremely sick:

May be limp and floppy like a rag
doll.

May not respond at all to being held, touched, or talked
to.

May be hard to wake up.

A baby that is sick (but not extremely
sick):

May be sleepier than usual.

May not eat
or drink as much as usual.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

Call your doctor now to discuss the symptoms and
arrange for care.

If you cannot reach your doctor or you don't have
one, seek care in the next hour.

You do not need to call an
ambulance unless:

You cannot travel safely either by driving
yourself or by having someone else drive you.

You are in an area
where heavy traffic or other problems may slow you down.

Seek Care Today

Based on your answers, you may need care soon. The
problem probably will not get better without medical care.

Call your doctor today to discuss the symptoms
and arrange for care.

If you cannot reach your doctor or you don't
have one, seek care today.

Home Treatment

Newborns and babies younger than 1 year of age

Don't wait until you see signs of dehydration in your baby. These signs include your baby being thirstier than usual and having less urine than usual.

If you breastfeed your baby, nurse him or her more often. Offer each breast to your baby for 1 to 2 minutes every 10 minutes.

If you use a bottle to feed your baby, increase the number of feedings to make up for lost fluids. The amount of extra fluid your baby needs depends on your baby's age and size. For example, a newborn may need as little as 1 fl oz (30 mL) at each extra feeding, while a 12-month-old baby may need as much as 3 fl oz (90 mL) at each extra feeding.

Ask your doctor if you need to use an oral rehydration solution (ORS) if your baby still isn't getting enough fluids from formula or the breast. The amount of ORS your baby needs depends on your baby's age and size. You can give the ORS in a dropper, spoon, or bottle.

If your baby has started eating cereal, you may replace lost fluids with cereal. You also may feed your baby strained bananas and mashed potatoes if your child has had these foods before.

Children ages 1 through 11

Make sure your child is drinking often. Frequent, small amounts work best.

Allow your child to drink as much fluid as he or she wants. Encourage your child to drink extra fluids or suck on flavored ice pops, such as Popsicles. Note: Do not give your child fruit juice or soda pop. Fruit juice and soda pop contain too much sugar and not enough of the essential minerals (electrolytes) that are being lost. Diet soda pop lacks calories that your child needs.

Cereal mixed with milk or water may also be used to replace lost fluids.

Blood or yellow or green liquid (bile) is present in your child's vomit.

Your child's vomiting does not get better.

Your child's symptoms become more severe or frequent.

Prevention

Babies

It is normal for babies to spit up after a feeding. Vomiting after a single feeding may happen sometimes and does not mean your baby has a problem. Repeated vomiting after feedings is more of a concern. The following tips may help your baby spit up less often. If this advice does not help, talk with your doctor.

Feed your baby smaller amounts at each feeding.

Feed your baby slowly.

Hold your baby during feedings.

Do not prop your baby's bottle.

Do not place your baby in an infant seat during feedings.

Try a new type of bottle or use a nipple with a smaller opening to reduce air intake.

Limit active and rough play after feedings.

Try putting your baby in different positions during and after feeding.

Burp your baby frequently during feedings.

Consider talking to your doctor about starting your baby on hypoallergenic formula. About 1% of babies who spit up are allergic to milk protein.

Do not add cereal to formula without first consulting your child's doctor.

Do not smoke when you are feeding your baby. Children who are exposed to tobacco smoke are more likely to develop illnesses that cause vomiting. If you smoke, quit. If you can't quit, do not smoke when you are holding or feeding your baby or when you are in the house or the car. For more information, see the topic Quitting Smoking.

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